Breaking Down Barriers to Better Health

Date:
2018-04-04

While the concept of “social determinants of health” (SDoH) has recently become a hot topic across the healthcare industry, this very notion has been driving our organization for more than a decade. We just called it something else: life barriers.

“Social determinants of health are the conditions in which people are born, live, learn, work, play, worship and age that affect health outcomes and risks, functioning, and quality of life.”

- World Health Organization

A new short-format video produced through Centene’s industry-academia partnership, the Envolve Center for Health Behavior Change™, sets the stage for current and future investigation into the impact of social determinants on health behaviors and health outcomes. It features powerful dialogue delivered by panelists at a forum on SDoH held at the Envolve Center last spring, coupled with compelling images of some of the many life barriers faced by economically disadvantaged individuals.

“If your housing is unstable month to month, if you live in fear or concern that someone close to you is going to hurt you … if you don’t have enough money to cover essential expenses like food on a regular basis, how important is it going to be for you to get vaccinated, get a mammogram, or for you to take your child to a well-child check-up?”

Matthew Kreuter, professor and faculty director, Envolve Center

“Access to healthcare is only one piece of a much larger puzzle,” says Michal Grinstein-Weiss, Envolve Center director, and associate dean for policy initiatives and professor at the George Warren Brown School of Social Work at Washington University in St. Louis. “While genetics, biology and health behaviors play a role, according to the Centers for Disease Control and Prevention, 75 percent of population health is driven by social determinants. Addressing the social determinants that drive health outcomes is a significant component of the Envolve Center’s work.”

Having spent a lifetime shaped by, overcoming, and working to address barriers to health, Dr. Gloria Wilder, vice president of innovation and preventive health at Centene takes a broad view. Says the practicing physician, “It’s important to realize that social determinants actually impact everybody. There are influences within a community that affect every individual; unfortunately, those with the least economic power are often affected most. I encourage everyone to look at your own barriers and challenges and whether you’ve overcome them.”

Researchers at the three-year-old Envolve Center have already delivered some informative results rooted in SDoH. They completed several in-depth studies focused on engaging and supporting Centene Medicaid members through Envolve’s health coaching programs. Significantly, they found that members who reported facing life barriers or with unmet basic needs were more likely to have negative health outcomes.

Below are some initial research results from the Envolve Center:

Medicaid members with diabetes enrolled in Envolve’s coaching program were 55 percent more likely to have an inpatient visit if they faced barriers, many of which were related to social determinants, as compared to similar members for whom such barriers were not observed.

In an online survey exploring Medicaid members’ life values and their association with health attitudes and behaviors, only 9 percent cited health directly as something that would make their life better, while more than 50 percent cited SDoH (35 percent family needs, 12 percent job, 9 percent money).

A survey of moderate- to low-income individuals found that all basic needs – such as access to food, housing and transportation – are correlated. Thus, addressing any basic need should have a positive effect on people’s lives.

This research has advanced the understanding of what drives health outcomes, particularly around basic needs, notes Grinstein-Weiss. “Specifically, we have found that strong social supports and a sense of purpose are key predictors of health behaviors, and our ‘peer coaching’ models lead participants to raise concerns about factors that are driving their health more frequently than other models. With further work and collaboration in this area, we believe significant progress is possible to help families live healthier lives.”

The Center’s research findings also validate Centene’s belief that addressing SDoH is essential for more effectively improving individual and community health. By creating environments that empower people with the resources they need to break through life barriers, we will enable them to better manage their own health. This vision aligns squarely with the company’s mission of improving the health of our communities, one individual at a time.

“We are uniquely positioned to lead the way in the 29 states where we have health programs,” says Dr. Wilder. “If we do it right, it will be groundbreaking to see how healthcare delivery occurs in this country, and we will have been the company that ushered healthcare into the 21st century!”